Neurology I Highlights Flashcards
Coma is when a pt is unarousable and unresponsive for ___________
> 1 hr
True or false: Reflexes may still be intact with coma
True
What do you need to repeat when a pt is in a coma?
Neurological checks
What is a diagnosis of brain death based on?
Clinical exam
What LOC can still have sleep-wake cycles and make sounds?
Pts in a vegetative state
What LOC may appear awake but have no meaningful activity and no purposeful movement or meaningful speech?
Vegetative state
What LOC is characterized by inconsistent levels of consciousness and some self-awareness?
Minimally conscious
For each cause of coma, describe what the pupils would look like:
1) Toxic and metabolic disorders
2) Midbrain lesion or herniation
3) Pontine lesion
4) Opiate overdose
(not highlighted but she said it’s impt)
1) Normal (usually)
2) Unilateral or bilateral “blown” pupils
3) Small, responsive to light bilaterally
4) Pinpoint pupils bilaterally
Motor function is absent and cognition is intact in what LOC?
Locked-in syndrome
What LOC pts are mute and quadriplegic, but still conscious?
Locked-in syndrome
In what LOC is the corticospinal tract usually affected?
Locked-in syndrome
What is aphasia and what causes it?
Inability to express or receive written/verbal communication; damage to Wernicke’s or Broca’s areas
1) Define agnosia
2) What causes it?
3) Give examples
1) Inability to recognize things/people/places
2) Damage to parietal, temporal or occipital lobes
3) Astereognosis, topographic agnosia
1) Define apraxia
2) What can cause it?
1) Disordered skilled movements; can perform, but does so incorrectly
2) Can be widespread or focal cerebral damage
1) Define amnesia
2) List some potential causes
1) Memory loss (recent or new memories)
2) Damage to hippocampus: stressful events, ischemia, h/o migraines, advanced age, injuries, drugs, alcohol, trauma, neurologic conditions
Subdural hematomas affect what?
Bridging veins
How do you know if something is a subdural hematoma?
CT scan; will not cross midline
Subdural hematoma:
1) Most patients present with ipsilateral ______________ and contralateral _____________.
2) You should check to see if patient is on what meds?
1) pupillary dilation; hemiparesis
2) Anticoagulants
When do you need to intubate a pt on the Glasgow coma scale?
If = or > 8
How do you test for subdural hematoma?
(not highlighted but emphasized in class)
“Halo” of CSF around bloody discharge on white cloth/coffee filter
Characterizing Headaches: What are some main ways to do this?
Primary and secondary & acute and chronic
How do you Tx subdural hematomas?
Admit to hospital and neurosurgery consult
What is your job as a PA when a pt presents with a headache?
Decide if “benign” headache vs. headache with dangerous neurologic or systemic pathology (Red Flag)
Most headache diagnoses are based primarily on which of the following?
A. history
B. exam findings
C. laboratory testing
D. imaging
A. history
Most headache diagnoses made based on what?
A detailed history
1) What headaches are episodic, severe, unilateral with periorbital pain?
2) How long do these headaches last?
1) Cluster headaches
2) 15 min - 3 hr
A pt being agitated and their headache being worse with activity are characteristics of what?
Cluster headaches
Name one example of a trigeminal autonomic cephalgia
Cluster Headaches
How to rule out DDxs for cluster headaches?
Ipsilateral autonomic symptoms
What is the main Tx for cluster headaches?
High flow O2 via non-rebreather mask
True or false: Migraine patients will have normal neuro exam.
True
Migraine headaches last how long?
4-72 hrs w/o tx
What should you not mistake a migraine for?
A stroke
List 4 primary characteristics of migraines
1) Unilateral
2) Pulsating
3) Nausea or vomiting
4) Photo or phonophobia
What type of HA is much more common in females?
Migraines
How do you differentiate migraines and strokes?
Normal neuro exam w. migraine
Migraine HA Tx:
Triptans: preferred nasal sprays or injections can be used in patients with n/v, but are CONTRAINDICATED in _____________ and _______________
CAD and cerebrovascular disease
Combo therapy is the highest yield migraine Tx, aka __________ + ____________.
NSAIDs + Triptans.
(can also add metoclopramide or Compazine in pts with n/v as well)
What should you avoid in treating migraine pts?
NEVER Rx opioids
Are tension headaches pulsating? Describe them
Non-pulsating; not aggravated by routine physical activity
True or false: Corticosteroids can be used to reduce occurrence of migraines, but do not work acutely
True
True or false: migraines are throbbing, not pulsating
True
What is the most common headache type?
Tension headaches
True or false: Tension headaches involve heightened sensitivity of pain pathways in the CNS, and focal neuro deficits
FALSE; NO focal neuro deficits
Tension headaches:
1) What is most likely if it’s chronic?
2) What are some DDxs?
3) What are the potential Txs?
1) Chronic = typically secondary to medication overuse or depression
2) Migraines, cluster HA, medication overuse, sinus HA
3) NSAIDs, nonpharmacologic interventions (acupuncture, massage, trigger point injections, PT)
* Note, Botox does not work here*
What is the most common type of headache seen in primary care?
A. cluster
B. migraine
C. tension
D. post traumatic
C. tension
List 2 important low-risk HA criteria
1) Not “worst headache ever”
2) Normal neuro exam
What is the SNNOOPPPP mnemonic for red flag Sx in pts with headaches?
Systemic symptoms (fever, rash, myalgia, WL, HTN)
Neoplasm (Hx CA)
Brain primary or mets
Neurologic deficit or dysfunction (focal exam, Sz AMS/cognitive changes)
Onset abrupt (thunderclap HA)*
Older patient (> 50 y/o)
**Pattern change or new type of HA
**Papilledema
Painful eye
Pregnancy
What 4 severe headache Sxs warrant emergent evaluation?
1) Thunderclap HA
2) Fever with neck stiffness
3) Papilledema with focal neuro signs or impaired MS
4) Acute glaucoma
True or false: Stable primary headaches rarely need neuroimaging
True
What likely suggests an underlying cause with headaches?
Abnormal neuro exam
Bells Palsy is sudden onset palsy of CN _____ (______ nerve) due to nerve inflammation that affects the ____________ and face.
CN VII (facial nerve); forehead
Will other neuro deficits besides CNVII be found in Bell’s Palsy?
NO OTHER neuro deficits
Symptoms that can occur due to damage to the lower cranial nerves (CN 9-12) are called what?
Bulbar palsy
What Dx should you be thinking of if a pt has Bulbar palsy?
ALS
